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BETWEEN THE
OF INSPECTOR GENERAL
OFFICE
OF THE
DEPARTMENT OF HEALTH AND HUMAN SERVICES
AND
MAXIMUS, INc.
I. PREAMBLE
Maximus, Inc., on behalf of the Maximus Consulting Segment, hereby enters into
this Corporate Integrty Agreement (CIA) with the Office of Inspector General (OIG) of
the United States Departent of Health and Human Services (HHS) to promote
compliance with the statutes, regulations, and written directives of Medicare, Medicaid,
and all other Federal health care programs (as defined in 42 U.S.c. 1320a-7b(f))
(Federal health care program requirements). Contemporaneously with this CIA,
Maximus is entering into Settlement Agreement with the United States.
A. The period of the compliance obligations assumed by Maximus under this CIA
shall be five years from the effective date of this CIA, unless otherwise specified. The
effective date shall be the date on which the final signatorx of this CIA executes this CIA
(Effective Date).. Each one-year period, beginning with the one-year period following the
Effective Date, shall be referred to as a "Reporting Period."
B. Sections VII, IX, X, and XI shall expire no later than 120 days after OIG's
receipt of: (1) Maximus' final annual report; or (2) any additional materials submitted by
Maximus pursuant to OIG's request, whichever is later.
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health care program reimbursement and/or who perform claiming
functions relating to Federal health care programs;
Notwithstanding the above, this term does not include part-time or per diem
employees, contractors, subcontractors, agents, and other persons who are
not reasonably expected to work more than 160 hours per year, except that
any such individuals shall become "Covered Persons" at the point when
they work more than 160 hours during the calendar year.
Maximus shall revise and enhance its existing Compliance Program such that it
includes the following elements:
Maximus shall report to OIG, in writing, any changes in the identity or position
description of the Compliance Officer, or any actions or changes that would affect the
Compliance Officer's ability to perform the duties necessary to meet the obligations in
this CIA, within 15 days after such a change.
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2. Compliance Committee. Within 90 days after the Effective Date,
Maximus shall appoint a Compliance Committee. The Compliance Committee shall, at a
minimum, include the Compliance Officer and other members of senior management
necessary to meet the requirements of this CIA (~, senior executives with relevant
responsibilities such as quality assurance, contract management and oversight, audit, and
operations). The Compliance Officer shall chair the Compliance Committee and the
Committee shall support the Compliance Officer in fulfilling his/her responsibilities (~,
the organization's risk areas and shall oversee monitoring of
shall assist in the analysis of
the
Maximus shall report to OIG, in writing, any changes in the composition of
Compliance Committee, or any actions or changes that would affect the Compliance
Committee's ability to perform the duties necessary to meet the obligations in this CIA,
within 15 days after such a change.
B. Written Standards.
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d. the requirement that all of Maximus' Covered Persons shall be
expected to report to the Compliance Officer, or other appropriate
individual designated by Maximus, suspected violations of any
Federal health care program requirements or of Maximus' own
Policies and Procedures;
Within 90 days after the Effective Date, each Relevant Covered Person shall
certify, in writing, that he or she has received, read, understood, and shall abide by
Maximus' Code of Conduct. Within 150 days after the Effective Date, all other Covered
Persons shall certify, in writing, that he or she has received, read, understood, and shall
abide by Maximus' Code of Conduct. New Covered Persons shall receive the Code of
Conduct and shall complete the required certification within 90 days after becoming a
Covered Person or within 150 days after the Effective Date, whichever is later. New
Relevant Covered Persons shall receive the Code of Condltct and shall complete the
required certification within 30 days after becoming a Relevant Covered Person or within
90 days after the Effective Date, whichever is later.
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a. the subjects relating to the Code of Conduct identified in Section
IILB.l ;
At least annually (and more frequently, if appropriate), Maximus shall assess and
update, as necessary, the Policies and Procedures. Within 30 days after the effective date
of any revisions, the relevant portions of any such revised Policies and Procedures shall
be distributed to all individuals whose job functions relate to those Policies and
Procedures.
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Date. Maximus shall provide at least one hour of General Training to other Covered
Person within 150 days of the Effective Date This training, at a minimum, shall explain
Maximus' :
New Covered Persons shall receive the General Training described above within
30 days after becoming a Covered Person or within 90 days after the Effective Date,
whichever is later. After receiving the initial General Training described above, each
Covered Person shall receive at least one hour of General Training in each subsequent
Reporting Period.
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g. applicable reimbursement statutes, regulations, and program
requirements and directives;
New Relevant Covered Persons shall receive this training within 60 days after the
beginning of their employment or becoming Relevant Covered Persons, or within 90 days
after the Effective Date, whichever is later. A Maximus employee who has completed
the Specific Training shall review a new Relevant Covered Person's work, to the extent
that the work relates to the delivery of patient care items or services and/or the
preparation or submission of claims for reimbursement from any Federal health care
program, until such time as the new Relevant Covered Person completes his or her
Specific Training.
After receiving the initial Specific Training described in this Section, each
Relevant Covered Person shall receive at least 3 hours of Specific Training in each
subsequent Reporting Period.
where appropriate, update the training to reflect changes in Federal health care program
requirements, any issues discovered during internal audits or the Consulting Contract
Review and any other relevant information.
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qualified and knowledgeable staff or trainers to answer questions or provide additional
information to the individuals receiving such training.
D. Review Procedures.
1. General Description.
$100.41). Maximus wil pay all OAS invoices within 30 days of the
receipt of an invoice.
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Maximus' revenues based on the contract.
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4. Notifcation to Parties Affected by Results of Consulting Contract
Review. In accordance with Section IILH.l, Maximus shall notify in
writing within 30 days the Client and the appropriate representative of the
relevant state and/or federal health care program affected by the results of.
the Consulting Contract Review. If the Client is affected by the results of
the claims review, Maximus' notification wil include a quantification of
the potential overpayment. Maximus shall make available to OIG all
documentation that reflects Maximus compliance with this section.
Nothing in this Agreement wil affect any rights of Maximus any Client of
to review and appealwith the affected federal health care program any
potential overpayment identified by the OAS audit.
5. Claims Review Report. OAS shall prepare a report based upon the
Consulting Contract Review.
E. Disclosure Program.
Within 90 days after the Effective Date, Maximus shall establish a Disclosure
Program that includes a mechanism (~, a toll-free compliance telephone line) to enable
individuals to disclose, to the Compliance Officer or some other person who is not in the
disclosing individual's chain of command, any identified issues or questions associated
with Maximus' policies, conduct, practices, or procedures .with respect toa Federal health
care program believed by the individual to be a potential violation of criminal, civil, or
administrative law. Maximus shall appropriately publicize the existence of the disclosure
mechanism (~, via periodic e-mails to employees or by posting the information in
prominent common areas).
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internal review of the allegations set forth in the disclosure and ensure that proper follow-
up is conducted.
The Compliance Officer (or designee) shall maintain a disclosure log, which shall
include a record and summary of each disclosure received (whether anonymous or not),
the status of the respective internal reviews, and any corrective action taken in response
to the internal reviews. the disclosure log shall be made available to OIGupon request.
F. Ineligible Persons.
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a. Maximus shall screen all Screened Persons against the Exclusion
or
Lists prior to engaging their services and, as part of the hiring
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4. Notifcation of Affected Parties of Ineligible Person: If Maximus has
actual notice of that it has employed an Ineligible Person, Maximus wil notify in writing
within 30 days any person or entity who has submitted Or wil likely submit claims to any
Federal health care program for work performed by the Ineligible Person on behalf of
Maximus.
Within 30 days after discovery, Maximus shall notify OIG, in writing, of any ongoing
investigation or legal proceeding known to Maximus conducted or brought by a
governmental entity or its agents involving an allegation thatMaximus has committed a
crime or has engaged in fraudulent activities. This notification shall include a description
of the allegation, the identity of the investigating or prosecuting agency, and the status of
such investigation or legal proceeding. Maximus shall also provide written notice to OIG
within 30 days after the resolution of the matter, and shall provide OIG with a description
of the findings and/or results of the investigation or procet1,dings, if any.
H. Reporting.
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b. Reporting of Potential Problems with Consulting Contract. If, at
any time, Maximus identifies or learns of any Potential Problem with
a Consulting Contract, Maximus shall notify the Client and the
appropriate representative of the relevant state and/or federal health
care program of the potential problem and take remedial steps where
possible within 60 days after identification (or such additional time
as may be agreed to by the appropriate representative of the relevant
federal health care program) to correct the problem In addition,
within 60 days after identification, Maximus wil undertake a review
to determine any other contracts that are affected by the issue
identified and notify the Client( s) and the appropriate representative
of the relevant state and/or federal health care program of the issue.
2. Reportable Events.
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i. If the Reportable Event is Potential Problem with a
Consulting Contract, the report to OIG shall be made at the
same time as the notification to the affected pary as required
in Section IILH.1, and shall include the affected party's name,
address, and contact person to whom the Notification was
sent;
A. Implementation Report. Within 120 days after the Effective Date, Maximus
shall submit a written report to OIG summarizing the status of
the its implementation of
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the
1. the name, address, phoIfenumber, and position description of
A copy of all training materials and the documentation supporting this information shall
be available to OIG, upon request.
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10. a list of all of Maximus' locations (including locations and mailing
addresses); the corresponding. name under which each location is doing business; the
corresponding phone numbers and fax numbers;
B. Annual Reports. Maximus shall submit to OIG annually a report with respect
the
to the status of, and findings regarding, Maximus' compliance activities for each of
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A copy of all training materials and the documentation supporting this information shall
be available to DIG, upon request.
during the Reporting Period and the status of any corrective and preventative action
relating to all such Reportable Events;
Consulting Contracts broken down into the following categories: State or governmental
entity(s); description of cause for problem; and other states or governmental entity(s)
with same or similar methodology.
10. any changes to the process by which Maximus fulfills the requirements
of Section IILF regarding Ineligible Persons;
11. the name, title, and responsibilities of any person who is determined to
be an Ineligible Person under Section IILF; the actions taken by Maximus in response to
the screening and removal obligations set forth in Section IILF; and the actions taken to
notify all states or governmental entity(s) under whose contract the Ineligible Person
performed work on behalf of Maximus;
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14. the certifications required by Section V.c.
The first Annual Report shall be received by OIG no later than 60 days after the
end of
by GIG
the first Reporting Period. Subsequent Annual Reports shall be received
no later than the anniversary date of the due date of the first Annual Report.
2. he or she has reviewed the Report and has made reasonable inquiry
regarding its content and believes that the information in the Report is accurate and
truthful;. and
otherwise stated in writing after the Effective Date, all notifications and
Unless
reports required under this CIA shall be submitted to the following entities:
OIG:
Administrative and Civil Remedies Branch
Office of Counsel to the Inspector General
Office of Inspector General
U.S. Department of Health and Human Services
Cohen Building, Room 5527
330 Independence Avenue, S.W.
Washington, DC 20201
Telephone: 202.619.2078
Facsimile: 202.205.0604
Maximus Corporate Integrity Agreement
July 2, 2007
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Maximus:
Adelaide Mayhew
MAXIMUS, Inc.
1356 Beverly Road
McLean, Virginia 22101
Fax (703) 251-8240
Unless otherwise specified, all notifications and reports required by this CIA may be
made by certified mail, overnight mail, hand delivery, or other means, provided that there
is proof that such notification was received. For purposes of this requirement, internal
facsimile confirmation sheets do not constitute proof of receipt.
In addition to any other rights OIG may have by statute, regulation, or contract,
OIG or its duly authorized representative(s) may
Maximus'
examine or request copies of
books, records, and other documents and supporting materials and/or conduct on-site
reviews of any of and evaluating: (a)
Maximus' locations for the purpose of verifying
Maximus' compliance with the terms of this CIA; and (b) Maximus' compliance with the
requirements of the Federal health care programs in which it participates. The '
documentation described above shall be made available by Maximus to OIG or its duly
authorized representative(s) at all reasonable times for insQection, audit, or reproduction.
Furthermore, for purposes of this provision, OIG or its duly authorized representative(s)
may interview any of Maximus' employees, contractors, or agents who consent to be
interviewed at the individual's place ofbusiness during normal business hours or at such
other place and time as may be mutually agreed upon between the individual and OIG.
Maximus shall assist OIG or its duly authorized representative(s) in contacting and
arranging interviews with such individuals upon OIG's request. Maximus' employees
may elect to be interviewed with or without a representative of Maximus present.
Maximus shall maintain for inspection all documents and records relating to work
performed under a contract that relates to reimbutsement from the Federal health care
programs, or to compliance with this CIA, for 6 years (or longer if otherwise required by
law) from the Effective Date.
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ix. DISCLOSURES
Consistent with HHS's FOIA procedures, set forth in 45 C.F.R. Part 5, OIG shall
make a reasonable effort to notify Maximus prior to any release by OIG of information
submitted by Maximus pursuant to its obligations under this CIA and identified upon
submission by Maximus as trade secrets, or information that is commercial or
financial
and privileged or confidential, under the FOIA rules. With respect to such releases,
Maximusshall have the rights set forth at 45 C.F.R. 5.65(d).
Maximus is expected to fully and timely comply with all of its CIA obligations.
a. a Compliance Officer;
"'
b. a Compliance Committee;
f. a Disclosure Program;
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2. A Stipulated Penalty of $2,500 (which shall begin to accrue on the day
after the date the obligation became due) for each day Maximus fails to pay an invoice of
OAS within 30 days of the receipt from OAS as required in Section IILD.
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or report, Stipulated Penalties for failure to perform the act or file the notification or
report shall not begin to accrue until one day after Maximus fails to meet the revised
deadline set by OIG. Notwithstanding any other provision in this Section, ifOIG denies
such a timely written request, Stipulated Penalties for failure to perform the act or
file the
notification or report shall not begin to accrue until three business days after Maximus
receives OIG's written denial of such request or the original due date, whichever is later.
A "timely written request" is defined as a request in writing received by OIG at least five
business days prior to the date by which any act is due to be performed or
any
notification or report is due to be filed.
any of the obligations described in Section X.A and after determining that Stipulated
Penalties are appropriate, OIG shall notify Maximus of: (a) Maximus' failure to comply;
and (b) OIG's exercise of its contractual right to demand payment of
the Stipulated
Penalties (this notification is referred to as the "Demand Letter").
Human Services," and submitted to OIG at the address set forth in Section VI.
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D. Exclusion for Material Breach of this CIA.
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timetable for curing the material breach.
E. Dispute Resolution
or of its Exclusion Letter, and as an agreed-upon contractual remedy for the resolution of
disputes arising under this CIA, Maximus shall be afforded certain review rights
comparable to the ones that are provided in 42 U.S.c. 1320a-7(f) and 42 C.F.R. Part
1005 as if they applied to the Stipulated Penalties or exclusion sought pursuant to this
CIA. Specifically,OIG's determination to demand payment of Stipulated Penalties or to
seekexclusion shall be subject to review by anHHS ALJ and, in the event of an appeal,
the HHS Departmental Appeals Board (DAB), in a manner consistent with the provisions
in 42 C.F.R. 1005.2-1005.21. Notwithstanding the langt1ige in 42 C.F.R. 1005.2(c),
the request for a hearing involving Stipulated Penalties shall be made within 10 days after
receipt of the Demand Letter and the request for a hearing involving exclusion shall be
made within 25 days after receipt of the Exclusion Letter.
in a proceeding for Stipulated Penalties under this CIA shall be: (a) whether Maximus
was in full and this CIA for which OIG
timely compliance with the obligations of
demands payment; and (b) the period of noncompliance. Maximus shall have the burden.
of proving its full and timely compliance and the steps taken to cute the noncompliance,
if any. OIG shall not have the right to appeal to the DAB an adverse ALJ decision
the ALJ agrees with OIG with regard to a finding of a
related to Stipulated Penalties. If
breach of this CIA and orders Maximus to pay Stipulated Penalties, such Stipulated
Penalties shall become due and payable 20 days after the ALJ issues such a decision
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unless Maximus requests review of the ALJ decision by the DAB. If the ALJ decision is
properly appealed to the DAB and the DAB upholds the determination ofOIG, the
Stipulated Penalties shall become due and payable 20 days afterthe DAB issues its
decision.
proceeding for exclusion based on a material breach of this CIA shall be:
c. whether the alleged material breach could not have been cured
within the 30-day period, but that: (i) Maximus had begun to take
action to cure the material breach within that period; (ii) Maximus
has pursued and is pursuing such action with due diligence; and (iii)
Maximus provided to OIG within that period a reasonable timetable
for curing the material breach and Maximus has followed the
timetable.
an ALJ decision favorable to OIG, or, if the ALJ rules for Maximus, only after a DAB
decision in favor ofOIG. Maximus' election of its contractual right to appeal to the DAB
shall not abrogate OIG's authority to exclude Maximus upon the issuance of an ALJ's
decision the ALJ sustains the determination ofOIG and determines
in favor ofOIG. If
that exclusion is authorized, such exclusion shall take effect 20 days after the ALJ issues
such a decision, notwithstanding that Maximus may request review of the ALJ decision
by the DAB. If the DAB finds in favor ofOIG after an ALJ decision adverse to OIG, the
exclusion shall take effect 20 days after the DAB decision. Maximus shall waive its right
to any notice of such an exclusion if a decision upholding the exclusion is rendered by the
ALlor DAB. If Maximus, Maximus shall be reinstated
the DAB finds iii favor of
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XI. EFFECTIVE AND BINDING AGREEMENT
B. This CIA shall become final and binding on the date the final signature is
obtained on the CIA;
C. This CIA constitutes the complete agreement between the parties and may not
be amended except by written consel1t of the parties to this CIA;
Maximus withdraws from participation in Federal health care programs and is relieved of ...
its CIA obligations by OIG, Maximus shall notify OIG at least 30 days in advance of
Maximus' intent to reapplyas a participating provider or supplier with any Federal health
care program. Upon receipt of such notification, OIG shall evaluate whether the CIA
should be reactivated or modified.
E. The undersigned Maximus signatories represent and warrant that they are
authorized to execute this CIA. The undersigned OIG signatory represents that he is
signing this CIA in his official capacity and that he is auth~rized to execute this CIA.
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ON BEHALF OF MAXIMUS
~ ~l:/wM4 DATE
.Jl) 11 '20 l 2-001
DA VID R. FRANCIS
General Counsel and Secretary
MAXIMUS, Inc.
"
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ON BEHALF OF THE OFFICE OF INSPECTOR GENERAL
OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES
GREGORY E. DEMSKE
~~/~
Assistant Inspector General for Legal Affairs
7(2~yl~
DATE
"'
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